FORMULIR

HASIL PEMERIKSAAN JENTIK DI TIAP RUMAH

DESA : Sukamekarsari KEC AMATAN : Kalanganyar

JENTIK
NO NAMA KK ALAMAT (RT/RW) JENIS CONTAINER JUMLAH
+ -
Pariuk Popojok Rt
1 Bp. H. Dani Bak Mandi 2
01. Rw 02

Pariuk Popojok Rt
2 Ibu .Suhanah Bak Mandi 1
01. Rw 02

Pariuk Popojok Rt
3 Abah Dana Bak Mandi 1
01. Rw 02

Pariuk Popojok Rt
4 Bp Yakub Bak Mandi 1
01. Rw 02

Pariuk Popojok Rt
5 Ibu .Sumarni Bak Mandi + Kulkas 2
01. Rw 02

Pariuk Popojok Rt
6 Bp. Sumardi Bak Mandi 1
01. Rw 02
Pariuk Popojok Rt Bak Mandi +
7 Bp. Satibi 2
01. Rw 02 dispenser

Pariuk Popojok Rt
8 Bp. Sarmedi Bak Mandi 1
01. Rw 02

Pariuk Popojok Rt Bak Mandi +

9 Ibu Murtamah 2
01. Rw 02 Gentong

Pariuk Popojok Rt Bak Mandi +

10 Bp. Astapura 2
01. Rw 02 Gentong

Pariuk Popojok Rt
11 Bp. Entus 01. Rw 02 Ember + Gentong 2

Pariuk Popojok Rt
12 Bp. Kasan Bak Mandi 1
01. Rw 02

Pariuk Popojok Rt
13 Bp. Bidong Ember + Gentong 2
01. Rw 02

Pariuk Popojok Rt
14 Bp. Sarudin Ember + Gentong 2
01. Rw 02

Pariuk Popojok Rt
15 Ibu munisah Ember + Gentong 2
01. Rw 02

Pariuk Popojok Rt
16 Ibu . Murdaiah Bak mandi 1
01. Rw 02

Pariuk Popojok Rt
17 Bp. Toni Bak mandi 1
01. Rw 02

Pariuk Popojok Rt
18 Ibu . Masni Bak mandi 1
01. Rw 02

Pariuk Popojok Rt
19 Bp . Sukri Gentong + Ember 2
01. Rw 02

Pariuk Popojok Rt
20 Bp. Maryadi Gentong + Ember 2
01. Rw 02

Mengetahui
Kalanganyar, 08 - Agustus- 2017
Kepala puskesmas kalanganyar Pelaksana Sanitasi

dr. Yudith Megawe A. Arief Laksana , AMKL

NIP, 19740524 200902 2 003 NIP, 19730905 200604 1 006
 FORMULIR
HASIL PEMERIKSAAN JENTIK DI TIAP RUMAH
DESA : Cikatapis KEC AMATAN : Kalanganyar

JENTIK
NO NAMA KK ALAMAT (RT/RW) JENIS CONTAINER JUMLAH
+ -

Bp. Albani Rahmat Kp. Ranca Gawe Rt Bak Mandi

1 3
01 Rw 01

Kp. Ranca Gawe Rt Bak Mandi +Kulkas

2 Ibu . Yanti 3
01 Rw 01 +Dispense

Kp. Ranca Gawe Rt Bak mandi

3 Ustad Jaenus 1
01 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
4 Ibu. Sapaah 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi +
5 Bp. Suroso 2
02 Rw 01 Gentong
Kp. Ranca Gawe Rt Bak Mandi + Ember
6 Bp. H. Usup 2
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi +
7 Bp. Yayat 2
02 Rw 01 dispenser
Kp. Ranca Gawe Rt Bak Mandi
8 Bp. Ajan 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi +
9 Ibu. Samsirah 2
02 Rw 01 Gentong
Kp. Ranca Gawe Rt Bak Mandi
10 Bp. Juman 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
11 Bp. Royanah 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
12 Ibu. Ratna 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
13 Bp. Saepul 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
14 Bp. Yuliani 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
15 Bp. Ade 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
16 Bp. Jasmani 1
02 Rw 01
Kp. Ranca Gawe Rt Bak Mandi
17 Bp. Rohani 1
02 Rw 01
Kp. Ranca Gawe Rt Bak mandi +
18 Bp. Halimi 1
02 Rw 01 Gentong
Kp. Ranca Gawe Rt Bak mandi +
19 Bp. Haerul 2
02 Rw 01 Gentong
Kp. Ranca Gawe Rt Gentong + Ember
20 Bp. Embay 2
02 Rw 01

Mengetahui Kalanganyar, 09 - Agustus- 2017

Kepala puskesmas kalanganyar Pelaksana Sanitasi

dr. Yudith Megawe A. Arief Laksana , AMKL

NIP, 19740524 200902 2 003 NIP, 19730905 200604 1 006